Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006

Abstract

Background: In Mali, malaria is the leading cause of death and the primary cause of outpatient visits for children under five. The twin towns of Mopti and Sévaré have historically had high under-five mortality. This paper investigates the changing malaria burden in children under five in these two towns for the years 1998-2006, and the likely contribution of previous interventions aimed at reducing malaria.

Methods: A retrospective analysis of daily outpatient consultation records from urban community health centres (CSCOMs) located in Mopti and Sévaré for the years 1998-2006 was conducted. Risk factors for a diagnosis of presumptive malaria, using logistic regression and trends in presumptive malaria diagnostic rates, were assessed using multilevel analysis.

Results: Between 1998-2006, presumptive malaria accounted for 33.8% of all recorded consultation diagnoses (10,123 out of 29,915). The monthly presumptive malaria diagnostic rate for children under five decreased by 66% (average of 8 diagnoses per month per 1,000 children in 1998 to 2.7 diagnoses per month in 2006). The multi-level analysis related 37% of this decrease to the distribution of bed net treatment kits initiated in May of 2001. Children of the Fulani (Peuhl) ethnicity had significantly lower odds of a presumptive malaria diagnosis when compared to children of other ethnic groups.

Conclusions: Presumptive malaria diagnostic rates have decreased between 1998-2006 among health care-seeking children under five in Mopti and Sévaré. A bed net treatment kit intervention conducted in 2001 is likely to have contributed to this decline. The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50% by 2011 as compared to levels in 2000.

Figure 1

Geographical location and aerial view of the study area. The aerial view shows the study area - Mopti and Sévaré, in Mali - extracted from an IKONOS satellite image (captured in April 2004, and provided by the GeoEye Foundation). The area is located within the bifurcated Niger and Bani Rivers.

Figure 2

Geographic location of community health centers (CSCOMs), Mopti and Sévaré, Mali. All seven urban CSCOMs located in Mopti (left) and Sévaré (right) are shown utilizing an IKONOS satellite imagery (captured in April 2004, and provided by the GeoEye Foundation) as reference. The catchment population of each CSCOM is roughly comprised by nearby residents.

Figure 3

Time-series of monthly incidence rates for malaria, acute respiratory infection, and infectious diarrhea between 1998 and 2006 plotted against monthly rainfall. Monthly rainfall (mm) plotted against malaria, acute respiratory infection (upper and lower combined), and infectious diarrhea monthly consultation rate per 1,000 children under age five in Sévaré and Mopti, Mali from January 1998 through December 2006. Key interventions to reduce malaria incidence, and the expansion of CSCOMs in the study area are indicated in the graph. Source: Monthly consultation registries and ADDs estimates.